Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Herpes Zoster


Medical Codes

ICD-9-CM:
053.10 - Herpes Zoster, with Unspecified Nervous System Complication
053.11 - Geniculate Herpes Zoster; Herpetic Geniculate Ganglionitis
053.12 - Herpes Zoster with Nervous System Complications, Other; Postherpetic Trigeminal Neuralgia
053.13 - Herpes Zoster with Nervous System Complications, Other; Postherpetic Polyneuropathy
053.14 - Herpes Zoster with Nervous System Complications, Other; Herpes Zoster Myelitis
053.19 - Herpes Zoster with Nervous System Complications, Other; Other
053.20 - Herpes Zoster with Ophthalmic Complications; Herpes Zoster Dermatitis of Eyelid; Herpes Zoster Ophthalmicus
053.21 - Herpes Zoster with Ophthalmic Complications; Herpes Zoster Keratoconjunctivitis
053.22 - Herpes Zoster with Ophthalmic Complications; Herpes Zoster Iridocyclitis
053.29 - Herpes Zoster with Ophthalmic Complications, Other
053.71 - Herpes Zoster with Other Specified Complications; Otitis Externa Due to Herpes Zoster
053.79 - h Other Specified Complications; Other
053.9 - Herpes Zoster without Mention of Complication; Herpes Zoster NOS

Related Terms

  • Shingles
  • Zoster

Overview

Herpes zoster, also called shingles, is a reactivation of the varicella-zoster virus (VZV) that causes chickenpox.

After an attack of chickenpox, the VCV can become dormant in a group of nerve cells or ganglion. Decades later, the virus can become active again and move through nerves to localized areas of the skin, typically on only one side of the body or face. This condition, called herpes zoster, is characterized by red patches of skin covered with small blisters (lesions) that are painful. These lesions contain the VCV, which can cause chickenpox in susceptible individuals.

Incidence and Prevalence: An estimated 1 million individuals are diagnosed with herpes zoster each year (Harpaz). During their lifetime, one-third of Americans will develop herpes zoster (Harpaz).

Worldwide, incidence of herpes zoster is similar to the US (Eastern).

Source: Medical Disability Advisor



Diagnosis

History: The individual may describe headache, light sensitivity (photophobia), and lethargy (malaise), followed by pain, burning, itching, tingling (paresthesias), or sensitivity in one area of the skin. This may be followed a few days later by a rash on the site. The rash soon evolves into lesions that start out clear but then become yellow or bloody and scab over. The lesions usually are present only on one side of the face and trunk and may be quite painful. Fever also may be reported. The individual usually has a history of having had chickenpox.

Physical exam: The exam may reveal very sensitive skin in the affected area. Although diagnosis is difficult before the lesions develop, a description of vague pain on one side of the body can be useful in diagnosing herpes zoster. The distribution of skin lesions typically occurs in an area controlled by a single spinal nerve (dermatome), although some may lie outside this area in adjacent dermatomes. Lymph nodes sometimes swell. Depending upon the area affected, there may be vision abnormalities, taste abnormalities, a drooping eyelid, hearing loss, or joint pain.

Tests: Tests rarely are done to diagnose herpes zoster but may include a viral culture of the skin lesion or a microscopic examination of skin cells (Tzanck test). Skin biopsy or direct fluorescent antibody (DFA) testing also may be performed cases that are difficult to diagnose. Blood tests may indicate an elevated white blood cell count. A chest x-ray may be recommended for immunocompromised individuals.

Source: Medical Disability Advisor



Treatment

Herpes zoster usually is self-limiting and is treated symptomatically. No drug can eliminate the virus, but antiviral drugs may shorten the duration of the disease, especially in immunocompromised individuals.

Corticosteroids have been used to reduce the inflammation associated with herpes zoster, but they may worsen the disease by interfering with the immune system. Antiviral medications may be prescribed to lessen viral shedding and shorten the duration of lesions. These medications also may decrease the chance of developing postherpetic neuralgia, especially if given within 72 hours of onset of symptoms (Eastern, Harpaz). Both medications may be prescribed for severe cases.

Analgesics such as aspirin or narcotics in severe cases also can be used to reduce moderate pain associated with the disease. Antihistamines may reduce pain and itching. In some cases, antidepressants are used for individuals with prolonged, severe pain and suicidal thoughts.

The skin should be kept clean to prevent secondary bacterial infections.

A vaccine is available to prevent chickenpox; however, the vaccine is new enough that it is not known what effect it has on herpes zoster. A live attenuated version of the vaccine has been shown to reduce the incidence of herpes zoster and postherpetic neuralgia by 51.3% (Oxman). This vaccine is recommended for all individuals aged 60 and older ("Shingles (Herpes Zoster) Vaccination"; Harpaz).

Source: Medical Disability Advisor



Prognosis

The rash associated with herpes zoster typically lasts for 7 to 10 days, and most individuals recover without complications within 2 to 4 weeks (Harpaz). Sometimes scarring of the skin occurs. Postherpetic neuralgia occurs in 10% to 18% of cases (Harpaz).

Although most individuals are immune to additional attacks of herpes zoster, recurrent attacks can occur (Harpaz).

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Family Physician
  • Neurologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Immune system disorders

Source: Medical Disability Advisor



Complications

Postherpetic neuralgia involves the persistence of pain, numbing, itching, or tingling in the area where herpes zoster occurred. This usually resolves within 6 months but may last for years and is more common in individuals over the age of 60 years (Eastern). If the facial nerves are affected, more serious complications can occur, such as facial paralysis (Ramsey Hunt syndrome, Bell’s palsy), vertigo, or hearing loss. The virus affects the eye (zoster ophthalmicus) in 10% to 25% of cases, leading to prolonged pain, scarring, and blindness (Harpaz). Other complications include bacterial infection of the lesions (streptococcal or staphylococcal infection), pneumonia, and inflammation of the brain (encephalitis); rarely, immunocompromised individuals may die from herpes zoster (Harpaz).

Source: Medical Disability Advisor



Factors Influencing Duration

The length of disability depends on which nerve group is affected and how much pain is experienced. If paralysis, deafness, or blindness occurs, the period of disability will increase. If postherpetic neuralgia or zoster ophthalmicus occurs, disability will also be extended.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Severe pain or eye involvement may restrict work for some individuals. If pain medication is needed, company policy on medication use should be reviewed to determine if medication usage is compatible with job safety and function.

In the case of paralysis or other complications, additional work restrictions may be necessary.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has diagnosis of herpes zoster been confirmed?
  • Has individual experienced extremely painful skin lesions, especially over a localized area of the face or trunk?
  • If diagnosis was uncertain, how have conditions with similar symptoms been ruled out?
  • Has individual experienced any complication related to the herpes zoster?
  • Did individual previously receive the chickenpox vaccine?
  • Does individual have underlying condition that increases the risk for herpes zoster, such as rheumatoid arthritis, systemic lupus erythematosus, Crohn’s disease, or ulcerative colitis?
  • Is individual immunocompromised?

Regarding treatment:

  • Do symptoms persist despite treatment?
  • Would individual benefit from antiviral drug therapy? Corticosteroid therapy?
  • Do symptoms impair function?
  • Is individual’s eye affected (zoster ophthalmicus)?
  • If affected by paralysis, is physical or occupational therapy indicated?
  • Is individual in severe pain? Depressed? Are antidepressants indicated?

Regarding prognosis:

  • If symptoms persist beyond expected duration, has temporary or permanent paralysis or postherpetic neuralgia occurred in the affected area?
  • Does individual have a coexisting condition, such as an immunosuppressive disorder (e.g., HIV infection/AIDS, cancer), that may complicate treatment or affect recovery?
  • Would individual benefit from pain management techniques or enrollment in a chronic pain clinic?
  • Is transition to less demanding duties, isolation from vulnerable co-workers, or limited disability warranted?

Source: Medical Disability Advisor



References

Cited

"Shingles (Herpes Zoster) Vaccination." Vaccines & Immunizations. 24 Sep. 2008. Centers for Disease Control and Prevention. 24 Feb. 2014 <http://www.cdc.gov/vaccines/vpd-vac/shingles/default.htm>.

Eastern, Joseph S. "Herpes Zoster." eMedicine. Eds. Franklin Flowers, et al. 2 Jul. 2009. Medscape. 16 Sep. 2009 <http://emedicine.medscape.com/article/1132465-overview>.

Harpaz, Rafael, Ishmael R. Ortega-Sanchez, and Jane F. Seward. "Prevention of Herpes Zoster: Recommendations of the Advisory Committee on Immunization Practices (ACIP)." Morbidity and Mortality Weekly Report 57 Early Release (2008): 1-30.

Oxman, M. N., et al. "Vaccination Against Herpes Zoster and Postherpetic Neuralgia." Journal of Infectious Diseases 197 Suppl 2 (2008): S228-S236.

Source: Medical Disability Advisor